Salivary Gland Infections

Salivary Gland Infections

What’s a salivary gland infection?

A salivary gland infection occurs when a bacterial or viral infection affects your salivary gland or duct. The infection can result from reduced saliva flow, which can be due to a blockage or inflammation of your salivary duct. The condition is called sialadenitis.

Saliva aids digestion, breaks down food, and works to keep your mouth clean. It washes away bacteria and food particles. It also helps control the amount of good and bad bacteria in your mouth. Fewer bacteria and food particles are washed away when saliva doesn’t freely travel throughout your mouth. This may lead to infection.

You have three pairs of large (major) salivary glands. They’re located on each side of your face. Parotid glands, which are the largest, are inside each cheek. They sit above your jaw in front of your ears. When one or more of these glands is infected, it’s called parotitis.

Causes of salivary gland infection

A salivary gland infection is typically caused by a bacterial infection. Staphylococcus aureus is the most common cause of salivary gland infection. Others causes of salivary gland infection include:

Streptococcus viridans
Haemophilus influenzae
Streptococcus pyogenes
Escherichia coli

These infections result from reduced saliva production. This is often caused by the blockage or inflammation of the salivary gland duct. Viruses and other medical conditions can also reduce saliva production, including:
mumps, a contagious viral infection that’s common among children who haven’t been immunized
HIV
influenza A and parainfluenza types I and II
herpes
a salivary stone
a salivary duct blocked by mucus
a tumor

Sjogren’s syndrome, an autoimmune condition that causes dry mouth
sarcoidosis, a condition in which patches of inflammation occur throughout the body
dehydration
malnutrition
radiation cancer treatment of the head and neck
inadequate oral hygiene

Risk factors for infection

The following factors can make you more susceptible to a salivary gland infection:
being over age 65
having inadequate oral hygiene
not being immunized against mumps

The following chronic conditions also can increase your risk of developing an infection:
HIV
AIDS
Sjogren’s syndrome
diabetes
malnutrition
alcoholism
bulimia
xerostomia, or dry mouth syndrome

Symptoms of salivary gland infection

The following list of symptoms may indicate a salivary gland infection. You should consult your doctor for an accurate diagnosis. Symptoms of a salivary gland infection can mimic those of other conditions. 

Symptoms include:
a constant abnormal or foul taste in your mouth inability to fully open your mouth
discomfort or pain when opening your mouth or eating
pus in your mouth
dry mouth
pain in your mouth
face pain
redness or swelling over your jaw in front of your ears, below your jaw, or on the bottom of your mouth
swelling of your face or neck
signs of infection, such as fever or chills

Contact your doctor immediately if you have a salivary gland infection and experience a high fever, trouble breathing or swallowing, or worsening symptoms. Your symptoms may require emergency treatment.

Potential complications

Salivary gland infection complications are uncommon. If a salivary gland infection is left untreated, pus can collect and form an abscess in the salivary gland.

A salivary gland infection caused by a benign tumor may cause an enlargement of the glands. Malignant (cancerous) tumors can grow quickly and cause loss of movement in the affected side of the face. This can impair part or all of the area.

In cases where parotitis happens again, severe swelling of the neck can destroy the affected glands.

You may also have complications if the initial bacterial infection spreads from the salivary gland to other parts of the body. This can include a bacterial skin infection called cellulitis or Ludwig’s angina, which is a form of cellulitis that occurs in the bottom of the mouth.

Diagnosis of salivary gland infection

Your doctor can diagnose a salivary gland infection with a visual exam. Pus or pain at the affected gland can indicate a bacterial infection.

If your doctor suspects a salivary gland infection, you may have additional testing to confirm the diagnosis and determine the underlying cause. The following imaging tests can be used to further analyze a salivary gland infection caused by an abscess, salivary stone, or tumor:

ultrasound
MRI scan
CT scan

Your doctor may also perform a biopsy of the affected salivary glands and ducts to test tissue or fluid for bacteria or viruses.

Treatment of salivary gland infection

Treatment depends on the severity of the infection, the underlying cause, and any additional symptoms you have, such as swelling or pain.

Antibiotics may be used to treat a bacterial infection, pus, or fever. A fine needle aspiration may be used to drain an abscess.

Home treatments include:
drinking 8 to 10 glasses of water daily with lemon to stimulate saliva and keep glands clear
massaging the affected gland
applying warm compresses to the affected gland
rinsing your mouth with warm salt water
sucking on sour lemons or sugar-free lemon candy to encourage saliva flow and reduce swelling

Most salivary gland infections don’t require surgery. However, it may be necessary in cases of chronic or recurring infections. Though uncommon, surgical treatment may involve removal of part or all of the parotid salivary gland or removal of the submandibular salivary gland.

Prevention

There’s no way to prevent most salivary gland infections. The best way to reduce your risk of developing an infection is to drink plenty of fluids and practice good oral hygiene. This includes brushing and flossing your teeth twice daily.

Myelo Fibrosis,

10 Symptoms of Myelofibrosis

By Mayar, Facty StaffUpdated: 

May 19, 2020

Myelofibrosis is a type of cancer that affects bone marrow. Bone marrow is the part of the body that is responsible for forming new blood cells. You may think of bone marrow as a factory for making blood cells. In myelofibrosis fibrosis, a certain gene mutation causes the bone marrow to produce a lot of blood cells at some stage. Abnormal cells in the bone marrow start to produce certain substances called cytokines. One of these cytokines is called fibroblast growth factor, which replaces the tissue that forms blood cells by collagen fibrous tissue. This will decrease the bone marrow's ability to produce new blood cells, so the numbers of all types of blood cells will decrease which is called "pancytopenia."

1. The abdomen may feel Swollen

The abnormal blood cells may collect in the liver and spleen. Because there is a significant number of them and because they tend to grow rapidly, they can cause the liver and spleen to increase in size. That is why people affected by myelofibrosis will start to feel that their abdomen is swollen. They may also feel fullness or heaviness.





2. Fatigue

In myelofibrosis, the tissue that forms blood cells is replaced by collagen fibrous tissue. This will decrease the bone marrow's ability to produce new blood cells. Some of these affected cells are red blood cells. This is why the person who suffers from Myelofibrosis can develop anemia.

The decrease in the number of available red blood cells will cause many other symptoms as well. Fatigue is one of them because red blood cells are responsible for delivering oxygen to all of the cells in the body. When the numbers of red blood cells decrease, the different cells of the body will not be able to find an adequate amount of oxygen that it needs to produce energy. So, the person will feel tired and exhausted all the time.



3. Pale skin

This is also caused by the decreased numbers of red blood cells. The blood running through the vessels is what gives the skin its pinkish color, and the blood appears red in color because it contains red blood cells. Red blood cells are red because they contain red subunit called heme. Heme subunits are part of the hemoglobin protein of the red blood cells. It can help in binding Iron which, in turn, helps in binding oxygen. When there are less red blood cells, the blood will contain a lesser amount of that subunit. So, the skin will appear paler.



4. Dizziness and Shortness of breath

Because the number of red blood cells decreases, the cells in the brain do not get an adequate amount of oxygen they need for various function. This makes the person affected with Myelofibrosis feel dizzy and lightheaded. Many Patients may find it hard to focus, concentrate or perform challenging mental activities. They may also experience breathing difficulties in the form of shortness of breath. This shortness of breath becomes more obvious when the person tries to do some physical activity. It is also caused by a decreased number of red blood cells.



5. Infection

White blood cells are a crucial and vital part of the body's defense system. They help protect the body from many harmful organisms. In Myelofibrosis, the tissues responsible for producing white blood cells are replaced by fibrous tissue. This makes the bone marrow produce less White blood cells. That is why myelofibrosis patients have a low immunity and are more likely to get sick than normal people.



6. Bruising and easy bleeding

The fibrosis of parts of the bone marrow decreases its production of platelets as well. Platelets play a major role in forming clots and stopping the bleeding. The low number of platelets is scientifically termed "thrombocytopenia." It will lead to petechiae and bleeding from the gums, nose and under the skin. Petechiae are small red spots on the skin or mucous membrane resulting from bleeding of a small capillary vessel. Small petechiae can group together to form a larger purple or blue spot called ecchymoses. Myelofibrosis will also experience bleeding from minor trauma and an increase in the time needed so that the bleeding stops.



7. Bone pain

Some people with Myelofibrosis will experience some form of bone pain. It is a relatively common symptom. It occurs commonly in the long bone. Long bones are a type of bone present in the human body. The Femur, tibia, and fibula are examples of long bones. Pain in the joints, as well as inflammation in the joints, are also commonly associated with bone pain.



8. Weight loss

The people affected by myelofibrosis feel tired and exhausted all the time. This feeling is present even with no or minimal effort. As a direct result of their disease, they may start to lose their appetite and eat less or refuse to eat. This will may make them lose weight. The combination of fatigue, appetite loss, and weight loss will lead to a type of weakness that may progress to wasting of the body that is common in severe chronic disease. This is called cachexia, and it is also common in patients who have other types of cancers.



9. Gout and high uric acid levels

Myelofibrosis can increase the levels of uric acid in the blood. The cause of this high uric acid level is not yet clear. It is possible that myelofibrosis makes the body produce more uric acid or decreases the body's ability to remove it. High levels of uric acids are known as Gout. Some of the symptoms that indicate a person has developed gout include pain and swelling of the joint of the big toe, redness around the joint, and limitation of the movement of the joint.



10. Cutaneous myelofibrosis

Cutaneous myelofibrosis is a rare condition that usually happens in neonates who are exposed to an intrauterine infection; or those who are born with certain diseases like hereditary spherocytosis and twin transfusion syndrome. It affects the skin and leads to the formation of nodules in the dermis and the subcutaneous tissue of the skin.


10 Treatments for Bone Cancer
HomeConditionsCancer

By Charmaine, Facty 

StaffUpdated: Mar 17, 2021

Bone cancer is a cancerous tumor of the bone. There are both benign (noncancerous) tumors and malignant (cancerous) bone tumors, but only the malignant tumors destroy healthy bone density tissue. Benign tumors also grow in the body but do not spread, or destroy any bone tissue and are not usually a threat to life. A malignant tumor is primary bone cancer and is less common than cancer that metastasizes (spreads) to the bones in other parts of the body. Of primary bone cancer, there are a few different kinds, including Osteosarcoma, Chondrosarcoma and Ewing Sarcoma. There are many roads to go down in regards to treatment, but it’s a matter of finding the right one for your specific kind of bone cancer.

1. Radiation

Radiation therapy, also known as Radiotherapy, is often used in those suffering from bone cancer as secondary cancer. It helps to control the pain and also helps prevent the development of new pain. You can have either External Beam Therapy, which is when a radiation beam is directed at the bone, from outside the body or, Internal Radiotherapy. With this, you have an injection of radiation liquid, which is injected directly into the affected area and lasts for a couple of days in your body. Radiotherapy will not cure cancer but, it will slow the cancer growth and give you a better quality of life.




2. Chemotherapy

Targeting cancer that begins in your bones, chemotherapy uses a combination of anti-cancer drugs injected into the bloodstream, to destroy the cancer cells. Although chemotherapy works very well for different types of cancer, you may treatments at various stages of cancer. Before or after surgery to reduce the risk of the cancer returning, and sometimes you may have it along with radiotherapy. A course of treatment is made up of between 6-14 cycles. One cycle is a dose of drugs over many days in a hospital, then a break of a couple of weeks. If the cancer is advanced, you may have a course of chemotherapy to prolong life by slowing cancer and relieving symptoms.



3. Targeted therapy

Targeted therapy in bone cancer is when drugs are used to stop the growth and spread of cancer. It does this by killing the cancer cells, preventing the cancer cells from multiplying. It is called ‘targeted’ because they use a mix of drugs specifically chosen with regard to the patient’s type of cancer and their DNA. These drugs can be taken orally with pills at home or intravenously at the hospital. Not all cancers can be treated in this method, and the schedule of drugs is different in each patient. Targeted therapy can also be used in conjunction with chemotherapy and radiation therapy or surgery.



4. Surgery

Surgery for bone cancer is an option when other treatments have not been successful, or when your health professional decides cancer needs to come out of your body as soon as possible. The type of surgery needed depends on the size of cancer and where it is. Surgery includes removing the bone affected, or removing a part of the bone affected and replacing it with a prosthetic piece. This surgery is usually only used when the cancer is not attached to any other tissues surrounding the bone. Surgery is also used in amputation. By removing the entire arm or leg that was infected by cancer.



5. Mifamurtide medication

For a particular bone cancer called osteosarcoma, which usually affects children and young adults, a medication called Mifamurtide can be administered in combination with chemotherapy. A course of Mifamurtide will begin after surgery, to help prevent cancer returning. This drug works by stimulating the immune system to produce particular specialized cells, which kill the cancer cells. Taken by infusion, a course of treatment can be two times a week for 12 weeks then once a week for another 24 weeks.



6. Massage therapy

Massage therapy is not a cure for bone cancer, but studies have found that massage helps the wellbeing of cancer sufferers. Massage is used as a natural way to help cope with cancer and cancer treatments. Massage can help by reducing symptoms like some pain and nausea, anger and stress, fatigue, anxiety, and depression. Massage is used to help cancer patients feel better. Cancer patients interested in using massage to reduce the stress of the disease will have to find a professional massage therapist that can work with those patients currently having treatment.



7. Diet

Naturally, proper nutrition and eating well is essential for anyone’s health. When you have bone cancer and need treatment, your eating habits will change dramatically, your appetite will go up and down and tolerance to various food swill change. Before treatment, it is crucial to eat well, so you are better equipped to handle the side effects of the drugs. You need strength and a boost in your immune system to handle the treatment better. Foods high in protein and calories are best. During your treatment will be the hardest as you most likely won’t feel like eating anything so choose well when you decide what to put in your body. After treatment, it’s best to stick to low-fat milk and dairy, high fiber foods and lots of fruits and vegetables.



8. Vitamins and supplements

When in cancer treatment you are putting your body through a great deal. Along with a nutritional diet, it is important to take some dietary supplements and vitamins to make sure your body is receiving all the good things you need to stay healthy. It’s recommended to take multivitamins containing A, C, E< and B complex; also important are magnesium, calcium selenium and zinc. A probiotic is good to take to maintain gastrointestinal health and boosting your immune system. Fish oil can help to decrease inflammation, and for bone support, it is imperative to take Vitamin D and Calcium Citrate.



9. Yoga

Studies have shown that yoga can help manage depression, anxiety, and fear. Most of these things are prevalent in cancer suffers. When practiced during cancer treatment, pain and fatigue caused by the treatment can be significantly improved. What you learn in yoga about breathing techniques, as well as strengthening the body’s core, have an effect on the outlook and pain tolerance of cancer patients. You can expand your range of motion, improve circulation and reduce muscle tension, all beneficial for those going through a medical cancer treatment. You don’t have to be a professional yogi to reap the benefits of some of the key exercises, practiced regularly.



10. Aloe vera

Aloe vera is one of the most powerful plants around. It contains massive healing qualities and is full of vitamins like B1m B2, B3, B5, B6, B12 Vitamin C, and choline, plus zinc, calcium, copper, magnesium, and manganese. It’s this concoction, which is beneficial for bones. Aloe is often used in cancer patients directly onto the skin of those having radiotherapy, lessening the reaction in the skin. There have also been studies to suggest aloe taken in liquid form while on a cycle of chemotherapy, helped shrink the size of cancer. There are some side effects to ingesting large amounts of aloe vera so please talk to your doctor for more information.




10 Signs Of Bone Cancer
HomeConditionsCancer

By Glenda Taylor
Reviewed By Brindusa Vanta, MDUpdated: Apr 27, 2020

Primary bone cancer is rare, making up around 0.2 percent of all cancers, according to the American Society of Clinical Oncology. Researchers say the onset could be linked to hereditary factors, but a specific cause is not known. The majority of bone tumors are noncancerous. In many cases, when cancer is found in the bone it is secondary -- the tumors spread or metastasized from somewhere else and are thus not categorized as bone cancer. Bone cancer, or cancer that has reached the bones, has a variety of symptoms.



2. Tingling, Numbness, or a Burning Sensation

When bone cancer affects the nerves inside the bone, individuals describe a tingling, numb, or burning sensation. Nerve pain can be difficult to describe to a physician because it is unlike the usual types of pain. Bone cancer disrupts the normal activity of bone cells, irritating the interior nerves, injuring the nerve fibers, and increasing nerve sensitivity. Oncologists say that once the tumors interact with the nerves inside the bone, the tumor size increases, worsening these symptoms.



3. Joint Stiffness and Swelling

Bone cancers often develop near or in a joint in the upper arms or legs. Not only does the area around the joint become tender, but the tumor also causes stiffness, which affects the range of motion. Swelling and redness then develop in the area where the pain first developed, usually several weeks later. The individual may notice a lump or mass near the area as well. A physician will check the area for swelling and tenderness and changes in the surrounding skin.



4. Weakened Bones and Fractures

In most cases, bone tumors develop in the long bones of the upper arms and legs, and the pelvis. The tumors are usually benign but can be malignant. Cancer weakens the bone where the tumor exists and may cause fractures. Some individuals develop a noticeable limp or experience a sudden onset of severe pain in a bone that was previously sore, and this could be a sign of bone cancer. In some cases, x-rays for other conditions such as sprained ankles or knee injuries uncover benign tumors. Fractures in cancer-weakened bones can occur next to or through the bone tumor itself.



5. Low Back Pain

Bone cancer occurring in the pelvis may cause lower back pain and sciatica. Back pain is a widespread issue for adults, and this can delay a diagnosis of pelvic bone cancer. Individuals over the age of 45 are the demographic most commonly diagnosed with pelvic cancer, and diagnosis is often preceded by painful symptoms that last longer than a month. Affected people develop a sudden onset of back pain or sciatica that occurs primarily at night and becomes increasingly worse and unresponsive to changes in position or bed rest. Because there is no traumatic injury, most therapies to treat back pain are ineffective.




6. Fever

Most people with cancer contract a fever at some point. Although fever is rarely an early sign of bone cancer, it is a sign that the body is fighting an infection or illness. If cancer affects the immune system, it is harder for the body to fight off the infection. Fevers may signify that cancer has spread or is in an advanced stage. If pain accompanies the fever, or if it exceeds 103 F, seek medical attention.




7. Fatigue

Fatigue leaves people feeling exhausted after the simplest activities, and sleep does not improve the condition. Fatigue is an early symptom of most cancers, including bone cancer. Pain levels and anemia contribute to fatigue. However, medical professionals believe that anemia is directly related to the effects cancer has on the central nervous system, muscle-energy metabolism, and circadian rhythms. Poor nutrition can also contribute to fatigue in people with bone cancer.



8. Night Sweats

Some types of cancer cause night sweats, medically known as sleep hyperhidrosis. Overheating during sleep does not cause night sweats. Researchers believe the symptom has a connection with the hormonal changes that occur when diseases such as bone cancer affect the body. Night sweats could be the body's attempt to fight off cancer or a reaction to stress or anxiety. Fevers can also lead to sweating.



9. Loss of Appetite and Weight Loss

Another sign of bone cancer is the unintended loss of ten pounds or more. Weight changes and muscle loss are common cancer symptoms. Research shows that the body produces substances called cytokines, proteins created by both immune and non-immune cells, to fight off cancer. The production of cytokines causes a decrease in appetite, which leads to poor nutrition in addition to weight and muscle loss. Cachexia is a condition that causes extreme weight loss and muscle wasting, and is commonly seen in advanced cases of cancer.



10. Anemia

Bone cancer affecting the bone marrow may cause anemia, the lack of a healthy level of red blood cells or hemoglobin. Cancer interferes with the production of red blood cells, and low levels of hemoglobin prevent the body from getting the oxygen it needs. Symptoms of anemia include fatigue and weakness, shortness of breath, headaches, chest pains, irregular heartbeats, and lightheadedness. A physician can test for red blood cell levels using a complete blood count (CBC) test.

STOMACH CANCER,

Stomach cancer

Symptoms & causes
Diagnosis & treatment
Doctors & departments
Care at Mayo Clinic
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Overview

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Stomach cancer is an abnormal growth of cells that begins in the stomach. The stomach is a muscular sac located in the upper middle of your abdomen, just below your ribs. Your stomach receives and holds the food you eat and then helps to break down and digest it.

Stomach cancer, also known as gastric cancer, can affect any part of the stomach. In most of the world, stomach cancers form in the main part of the stomach (stomach body).

But in the United States, stomach cancer is more likely to affect the area where the long tube (esophagus) that carries food you swallow meets the stomach. This area is called the gastroesophageal junction.

Where the cancer occurs in the stomach is one factor doctors consider when determining your treatment options. Treatment usually includes surgery to remove the stomach cancer. Other treatments may be recommended before and after surgery.

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Symptoms

Signs and symptoms of stomach cancer may include:

Difficulty swallowing
Feeling bloated after eating
Feeling full after eating small amounts of food
Heartburn
Indigestion
Nausea
Stomach pain
Unintentional weight loss
Vomiting
When to see a doctor

If you have signs and symptoms that worry you, make an appointment with your doctor. Your doctor will likely investigate more-common causes of these signs and symptoms first.

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Esophageal cancer is cancer that occurs in the esophagus — a long, hollow tube that runs from your throat to your stomach. Your esophagus helps move the food you swallow from the back of your throat to your stomach to be digested.

Esophageal cancer usually begins in the cells that line the inside of the esophagus. Esophageal cancer can occur anywhere along the esophagus. More men than women get esophageal cancer.


Esophageal cancer is the sixth most common cause of cancer deaths worldwide. Incidence rates vary within different geographic locations. In some regions, higher rates of esophageal cancer may be attributed to tobacco and alcohol use or particular nutritional habits and obesity.

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Symptoms

Signs and symptoms of esophageal cancer include:

Difficulty swallowing (dysphagia)
Weight loss without trying
Chest pain, pressure or burning
Worsening indigestion or heartburn
Coughing or hoarseness

Early esophageal cancer typically causes no signs or symptoms.

When to see a doctor

Make an appointment with your doctor if you have any persistent signs and symptoms that worry you.

If you've been diagnosed with Barrett's esophagus, a precancerous condition caused by chronic acid reflux, your risk of esophageal cancer is higher. 

Ask your doctor what signs and symptoms to watch for that may signal that your condition is worsening.

Screening for esophageal cancer may be an option for people with Barrett's esophagus. 

If you have Barrett's esophagus, discuss the pros and cons of screening with your doctor.

THROAT CANCER - MAYO CLINIC,

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Throat cancer refers cancer that develops in your throat (pharynx) or voice box (larynx).

Your throat is a muscular tube that begins behind your nose and ends in your neck. Throat cancer most often begins in the flat cells that line the inside of your throat.

Your voice box sits just below your throat and also is susceptible to throat cancer. The voice box is made of cartilage and contains the vocal cords that vibrate to make sound when you talk.

Types of throat cancer

Throat cancer is a general term that applies to cancer that develops in the throat (pharyngeal cancer) or in the voice box (laryngeal cancer).

Though most throat cancers involve the same types of cells, specific terms are used to differentiate the part of the throat where cancer originated.

Nasopharyngeal cancer begins in the nasopharynx — the part of your throat just behind your nose.

Oropharyngeal cancer begins in the oropharynx — the part of your throat right behind your mouth that includes your tonsils.

Hypopharyngeal cancer (laryngopharyngeal cancer) begins in the hypopharynx (laryngopharynx) — the lower part of your throat, just above your esophagus and windpipe.

Glottic cancer begins in the vocal cords.
Supraglottic cancer begins in the upper portion of the voice box and includes cancer that affects the epiglottis, which is a piece of cartilage that blocks food from going into your windpipe.

Subglottic cancer begins in the lower portion of your voice box, below your vocal cords.

mRNA Vaccines for Cancer Treatment

New cancer treatments may be on the horizon—thanks to mRNA vaccines

(National Geographic)

The COVID-19 pandemic brought mRNA vaccines into the limelight. But the technology may also prove to be a powerful weapon against hard-to-treat cancers.

Molly Cassidy was studying for the Arizona bar exam in February 2019 when she felt an excruciating pain in her ear. The pain eventually radiated down through her jaw, leading her to discover a bump under her tongue. “I had several doctors tell me it was stress-related because I was studying for the bar and I had a 10-month-old son,” recalls Cassidy, who also has a Ph.D. in education. After continuing to seek medical care, she found out that she had an aggressive form of head and neck cancer that required intensive treatment.

After doctors removed part of her tongue along with 35 lymph nodes, Cassidy went through 35 sessions of radiation concurrent with three cycles of chemotherapy. Ten days after she completed treatment, Cassidy noticed a marble-like lump on her collarbone. The cancer had returned—and with a vengeance: It had spread throughout her neck and to her lungs. “By that point, I was really out of options because the other treatments hadn’t worked,” says Cassidy, now 38, who lives in Tucson. “In the summer of 2019, I was told my cancer was very severe and to get my affairs in order. I even planned my funeral.”

When doctors removed the tumor from her collarbone, they told her that she might be eligible to join a clinical trial at the University of Arizona Cancer Center that was testing an mRNA (messenger ribonucleic acid) vaccine—similar technology to the Pfizer and Moderna COVID-19 vaccines—in combination with an immunotherapy drug to treat colorectal and head and neck cancers. Whereas the COVID-19 vaccines are preventative, mRNA vaccines for cancer are therapeutic, and Cassidy jumped at the opportunity to participate. “I was at the right place at the right time for this clinical trial,” she says.

Back when people first heard about Pfizer-BioNTech and Moderna’s COVID-19 vaccines, the mRNA technology behind them sounded like the stuff of science fiction. But while the mRNA approach seems revolutionary, long before anyone had heard of COVID-19, researchers had been developing mRNA vaccines to fight cancer, autoimmune diseases such as multiple sclerosis, and to protect against other infectious diseases, such as the respiratory syncytial virus. 

“It’s not a new idea: What COVID has shown us is that mRNA vaccines can be an efficacious and safe technology for millions of people,” says Daniel Anderson, a leader in the field of nanotherapeutics and biomaterials at the Massachusetts Institute of Technology and a member of the Koch Institute for Integrative Cancer Research.

Currently, phase one and phase two clinical trials are recruiting participants or are underway to assess the efficacy, tolerability, and safety of therapeutic mRNA vaccines to treat various forms of cancer. These include melanoma, non-small cell lung cancers, gastrointestinal cancer, breast cancer, ovarian cancer, and pancreatic cancer, among others.

“One of the beauties of this technology is it can be used in people agnostic to their cancer type—it doesn’t matter if it’s a breast cancer or lung cancer as long as you can identify its mutations,” says Van Morris, a physician and an assistant professor of gastrointestinal medical oncology at the University of Texas MD Anderson Cancer Center in Houston who is leading a phase two clinical trial exploring the use of personalized mRNA vaccines for patients who have stage II or stage III colorectal cancer. “One of the exciting things is the adaptability of the technology based on a given cancer and the underlying biology of that cancer.”

Over the course of 27 weeks, Cassidy received nine injections of a personalized mRNA vaccine along with intravenous infusions of an immunotherapy drug called Pembrolizumab. She saw her doctor, Julie E. Bauman, deputy director of the University of Arizona Cancer Center, on a weekly basis at first then every three weeks; she also had regular CT scans. 

After each injection, Cassidy would spike a fever and feel wiped out—with fatigue and body aches and pains—for 24 hours. “My immune system was really flaring up, which is what we wanted to happen so it could fight the cancer,” she explains.

By the time the treatment concluded in October 2020, Cassidy’s CT scans were clean: There was no evidence of cancer in her body.

A MESSAGE IN A NEEDLE

On a basic level, “what we’re trying to do with the mRNA vaccine for cancer is alert the immune system to the tumor so the immune system will attack it—it’s basically biological software,” explains John Cooke, a physician and medical director of the Center for RNA Therapeutics at Houston Methodist. 

“Vaccines are being developed against cancers where there’s not a very good solution right now or where the cancers are likely to metastasize.”

Some mRNA vaccines for cancer take an off-the-shelf approach: These ready-made vaccines are designed to look for target proteins that appear on the surface of certain cancer tumors. How well they work is a matter of speculation right now, but some experts have concerns. 

“The question is: What is the target? You always have to have the right thing to target for the vaccine to be effective,” says David Braun, an oncologist at the Dana-Farber Cancer Institute and Harvard Medical School who specializes in immunotherapies. 

After all, with cancer, there isn’t a universal target the way there is with the coronavirus’s spike protein, and DNA mutations in cancer cells vary from one patient to another.

This is where personalized mRNA cancer vaccines enter the picture—and these may be more promising, experts say. With the personalized approach, a sample of tissue is taken from a patient’s tumor and their DNA is analyzed to identify mutations that distinguish the cancer cells from the normal, healthy cells, explains Bauman, who is also chief of hematology/oncology at the UA College of Medicine-Tucson. Computers compare the two DNA samples to identify the unique mutations in a tumor, then the results are used to design a molecule of mRNA that will go into the vaccine. This is typically done in four-to-eight-weeks—“it’s a technical tour de force to be able to do that,” says Robert A. Seder, chief of the Cellular Immunology Section of the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases.

After the mRNA vaccine is injected into the patient, the mRNA tells the patient’s cells to produce proteins that are associated with the specific mutations on their tumor. 

The tumor protein fragments that are created from the mRNA are then recognized by the patient’s immune system, Morris explains. 

Basically, the mRNA instructions train the immune system’s T cells—white blood cells that help us fight viruses—to recognize up to 20 mutations in cancer cells and attack only those. The immune system scours the body on a search-and-destroy mission looking for similar tumor cells.

“One of the things cancer does is it can turn on signals to tell the immune system to quiet down so the cancer is not detected,” explains Anderson. 

“The goal of an mRNA vaccine is to alert and gear up the immune system to go after the characteristic features of tumor cells and attack them.”

“Personalized cancer vaccines wake up specialized killer T cells that recognize abnormal cells and trigger them to kill the cells that are cancer,” Bauman says. “It’s a matter of using our own immune system as the army to eliminate the cancer.”

“This is the epitome of personalized medicine,” says Morris. “It’s a highly personalized, highly specific approach, not a one-size-fits-all treatment.”

CHALLENGES AHEAD

Despite the enthusiasm and promise for this type of cancer treatment, it is important to remember: “These are early days, and the results are going to be different than the immediate success of the COVID-19 vaccines,” says Seder. 

For one thing, mRNA cancer vaccines aren’t going to become available at record speed the way the COVID-19 vaccines did under emergency use authorization; the cancer vaccines will require years of testing and clinical trials.

One reason for the differences in the development time for COVID-19 mRNA vaccines versus cancer mRNA vaccines stems from their therapeutic goal. 

The current mRNA vaccines are intended to prevent COVID-19: They’re designed to protect people from the virus by providing a preview of the coronavirus’s distinctive spike protein, so that if they encounter the virus, their immune system can fight it off. 

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Another challenge with mRNA vaccines has been to figure out how to build a nanoparticle that effectively delivers messenger RNA to where it needs to go. “If it’s [left] unprotected, messenger RNA won’t enter cells, and it will be rapidly degraded when you put it in the body,” explains Anderson. “We can protect it and deliver it inside cells by encapsulating it in a lipid-like nanoparticle.” This way, the nanoparticles can evade the body’s clearance mechanisms and get into the right cells. (Currently, lipid-based nanoparticles are the most common delivery system used in clinical trials for mRNA vaccines to treat cancer.)

Even with an optimal delivery system, however, it’s unlikely that mRNA vaccines will be a panacea for all cancers. But they are another promising tool for the treatment of advanced or incurable cancers. And researchers are exploring whether mRNA vaccines can be combined with other immune-based therapies, such as checkpoint inhibitors (which release a natural brake on the immune system so that T cells can recognize and attack tumors) or adoptive T cell therapy (in which T cells are harvested from a patient’s blood or tumor, stimulated to grow in the lab, then reinfused into a patient to help the body recognize and destroy tumor cells).

At this point, there are few published studies of trials with mRNA cancer vaccines in humans, but there are glimmers of optimism. In a phase one trial that investigated the use of an mRNA vaccine along with an immune checkpoint inhibitor in the treatment of head and neck cancer or colorectal cancer, Bauman and her colleagues found noteworthy differences: In five of the 10 patients with head and neck cancer, the combination therapy shrank the tumors and two patients had no detectable cancer after the treatment; by contrast, the 17 patients with colorectal cancer failed to respond to the combination treatment.

“With colorectal cancer, there isn’t much immune system activity—the cancer cells are better at hiding,” explains Bauman. “In some cases, it may not be enough to show the immune system what the cancer looks like.” The T cells need to reach the cancer and eliminate it. That didn’t happen with the patients who had colorectal cancer.

HOPE ON THE HORIZON

Meanwhile, some promising findings are emerging from animal studies. In a study in a 2018 issue of the journal Molecular Therapy, researchers constructed an mRNA vaccine to be combined with a monoclonal antibody (a synthetic antibody made in the lab) to enhance the anti-tumor benefits in the treatment of triple negative breast cancer, which is notoriously aggressive and has a high rate of metastasis and a poor prognosis. They found that mice that were treated with the combination therapy had a significantly enhanced anti-tumor immune response compared to those who were given only the vaccine or the monoclonal antibody. And a study in a 2019 issue of the journal ACS Nano found that when mice with lymphoma (cancer of the lymphatic system) were given an mRNA vaccine along with a checkpoint inhibitor drug, they experienced significantly reduced tumor growth and 40 percent of them experienced complete tumor regression.

If mRNA vaccines prove to be effective, physicians and researchers hope that eventually vaccines could be developed to treat certain cancers, prevent recurrences, and possibly even prevent some cancers in those who are genetically predisposed to them. “I think this is going to be another arrow in the quiver for oncologists to give their patients a better chance,” says Cooke. “And if prophylactic cancer vaccines are shown to work, they could make cancer a preventable illness.”

In the meantime, Molly Cassidy is already a firm believer in the power of mRNA vaccines to treat aggressive cancers. These days, she’s feeling great and enjoying life as a stay-at-home mom with her three-year-old son, her husband, and her step-kids. “My doctor won’t say I’m cured, but she’s very happy with where I am,” says Cassidy. “This treatment saved my life, and I’m incredibly grateful to my doctors.”

Some experts say it’s conceivable that we could see an mRNA vaccine for cancer gain approval by the Food and Drug Administration within the next five years. “If we can leverage the ability of the immune system to precisely get rid of foreign invaders like cancer, that would be an amazing day,” says Bauman.

Tips for Managing Insomnia During Cancer Treatment,

Out of the Blue I received the following email and the article answers many of my questions...

Alexandra Hadfield <alexandra@mail.mattressadvisor.com>	12:00 AM (12 hours ago)
to me

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Tips for Managing Insomnia During Cancer Treatment

Learn how to alleviate insomnia symptoms during chemotherapy

By Jennifer

January 12, 2021


RELATED ARTICLES

SLEEP AND CANCERHOW SLEEP AND BREAST CANCER ARE

 RELATEDNight Sweats


A cancer diagnosis is worrisome enough that it can cause most anyone to lose sleep. In fact, 20% to 75% of newly diagnosed or recently treated cancer patients report sleep problems, according to Sleep Medicine Research—that’s about twice as much as the general population. But the most common treatment for cancer may also be to blame.

According to a study published in the journal Sleep, the first round of chemotherapy is linked to a temporary disruption of sleep-wake cycles in breast cancer patients. And, “repeated administration of chemotherapy resulted in progressively worse and more enduring impairments.”

Treatments That Can Cause Insomnia

Insomnia is a common sleep disorder in which you have difficulty falling asleep or staying asleep. Insomnia can be short-term (acute), lasting for days or weeks. Or, it can be a long-term (chronic) condition that lasts for a month or more. There are several cancer treatments that can contribute to insomnia.

Steroids

Cancer patients are sometimes treated with steroids to treat cancer, reduce inflammation, reduce the body’s immune response (such as after a bone marrow transplant), reduce chemotherapy-associated nausea, and improve your appetite. However, steroids may make it difficult for you to fall asleep, especially if you take them in the evening.

Anti-Sickness Drugs

Most patients treated with chemotherapy are also given anti-nausea drugs, or antiemetics, which block the nerve impulse that travels from the blood or stomach to the brain, where the vomiting center is located. While these drugs serve a great benefit to cancer patients, some (such as dexamethasone) have been associated with insomnia while others (such as Zofran) can cause drowsiness and sedation.

Hormones Treatment

Hormone therapy is used to stop or slow the growth of cancers that rely on hormones to grow, such as breast, endometrial, prostate, and adrenal cancers. It is sometimes called endocrine therapy. Hormone therapy side effects include fatigue and hot flashes which can also cause sleep problems.

Physical Factors of Chemotherapy and Sleep

Chemotherapy is a potent treatment designed to kill fast-growing cancer cells. The drug travels throughout the body, which means it can affect normal, healthy cells in its wake. Damaged healthy cells can cause side effects such as hair loss, infections, anemia, nausea, vomiting, constipation, diarrhea, mouth sores, nerve problems, urine and bladder changes, brain fog, and fertility problems.

Chemotherapy can also make you feel fatigued. You may even feel sleepy enough to nap during the day, which in turn makes falling to sleep at night more challenging. Cancer patients going through treatment may also experience mental health symptoms such as anxiety or depression, which also interferes with sleep.

Mental Health and Sleep

It’s not uncommon for people dealing with cancer to feel sad or anxious. A cancer diagnosis fills you with fear and uncertainty about the future. The stress caused by the ups and downs of treatment can also weigh on you heavily and lead to mental health issues that, in turn, can impact your sleep.

Cancer-related depression can be mild and short-lasting. But for a fourth of all cancer patients, it can feel oppressive and linger, leading to a condition called major depression or clinical depression.

Similar to depression, cancer-related anxiety can be mild and temporary. But some may become consumed with worry or fear of treatment or treatment-related side effects, fear of their cancer returning, even fear of dying.

Chronic anxiety and depression can lead to excessive fatigue and insomnia, and can greatly interfere with your quality of life.

Chemotherapy and Fatigue

People with insomnia may feel tired during the day, but fatigue is slightly different. Fatigue is less of a feeling of sleepiness and more of a prolonged energy drain. Some people who are fatigued may say they are so tired they can’t fall asleep. Cancer patients going through chemotherapy may experience insomnia, fatigue, or both at the same time.

Fatigue is a persistent and distressing sense of physical and emotional exhaustion that interferes with your normal, everyday activities and can significantly impact your quality of life, according to an analysis published in the journal Comparative Medicine.

Medications

Many of the therapies used to treat cancer can cause fatigue, including chemotherapy, radiation therapy, immunotherapy, and hormone therapy. Even painkillers used to relieve cancer pain can cause fatigue, such as powerful opioids like fentanyl, oxycodone, and morphine. Some patients on high-dose opioids may experience general tiredness for weeks.

Anemia

Anemia is when you don’t have enough healthy red blood cells to adequately deliver oxygen to your body’s tissues, which can cause fatigue. About 7 in 10 cancer patients will become anemic during chemotherapy because the treatment can adversely impact blood counts.

Hormonal Changes

Chemotherapy drugs can alter protein and hormone levels in both men and women. This can have an affect on the inflammatory processes in the body which, in turn, can cause or worsen fatigue.

Emotions

Going through cancer treatment can feel like you’re riding an emotional roller coaster. There are highs and lows, and white knuckle moments. Anxiety and depression are not uncommon and, for some, the fear and sadness can linger not only for patients, but their family members as well.

Pain

Pain in cancer patients may be caused by the disease or by the treatment they are undergoing. The amount of pain you feel depends on several variables including the type of cancer, its stage, the treatment you’re undergoing, and your overall tolerance to pain. Research shows that pain can interfere with sleep and contribute to fatigue. But a sleep deficit can also reduce the body’s tolerance to pain and worsen inflammation, leading to a seemingly endless cycle of pain and sleeplessness.

Decreased Nutrition

Side effects of chemotherapy or cancer itself can cause symptoms such as nausea, vomiting, mouth sores, and changes in taste sensation. These can cause a loss of appetite and lead to weight loss and malnutrition. When your body is malnourished, you feel exhausted and fatigued.

Combating Sleepless Nights

Schedule Rest

Fatigue can be overwhelming. Buy scheduling rest breaks throughout the day, you can reserve energy for when you need it the most, such as when you have visitors. If you feel you need a nap, limit them to no more than an hour so you won’t have trouble falling asleep at night.

Nutrition

Cancer symptoms as well as side effects from cancer treatments can zap your appetite and cause symptoms that make you want to avoid food, such as nausea, vomiting, and mouth sores. But getting nutrients and calories during chemotherapy can help fight fatigue and keep you strong and better able to withstand the effects of cancer and its treatments. This may mean taking advantage of more high-fat, high-calorie foods to maintain a healthy weight, or drinking cooling milkshakes to help numb painful mouth sores.

Hydration

Dehydration can happen to anyone, not just cancer patients. But people with cancer may be at higher risk due to treatment side effects like vomiting and diarrhea. Without enough fluids, the human body cannot function properly. Fatigue is one of the main symptoms of dehydration. So it is especially important for cancer patients to drink plenty of fluids—at least eight cups of water a day. Eating foods with high water content, such as watermelon and popsicles, can also help keep you hydrated.

Vitamins

According to a study published in the Journal of Clinical Oncology, between 14% and 32% of people newly diagnosed with cancer began using nutritional supplements, and many chose to use them to improve their nutrition or reduce adverse effects associated with cancer treatment including chemotherapy-related fatigue. However, patients who are considering using supplements should first talk with their doctors as some vitamins and supplements may interfere with the medication they are taking.

SLEEP RESOURCES
Sleep and Cancer

Does sleep deprivation cause cancer? Why do cancer patients have sleep troubles? Learn the answers to these questions in this guide.

SLEEP RESOURCES
Night Sweats

Don't let your night sweats interrupt a good night's sleep. Learn how to sleep through the night without losing your cool.

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Now Click on this link to see which mattress suits you best

MYELOFIBROSIS

Myelofibrosis is an uncommon type of bone marrow cancer that disrupts your body's normal production of blood cells.

Myelofibrosis causes extensive scarring in your bone marrow, leading to severe anemia that can cause weakness and fatigue.

What is the life expectancy of someone with myelofibrosis?
It does affect the life expectancy of the patients. The average survival is about 5 to 7 years. Unlike other myeloproliferative neoplasms, the name implies that these myeloid cells—they're the bone marrow cells—grow without control and overwhelm the bone marrow and blood

Is myelofibrosis a cancer?
Myelofibrosis is group of rare cancers of the bone marrow in which the marrow is replaced by scar tissue and is not able to make healthy blood cells. It is classified as a type of chronic leukemia and belongs to a group of blood disorders called myeloproliferative diseases.

Is there a cure for myelofibrosis?
A low-risk myelofibrosis may not require immediate treatment, while people with high-risk myelofibrosis may consider an aggressive treatment, such as bone marrow transplant. For intermediate-risk myelofibrosis, treatment is usually directed at managing symptoms.May

What causes myelofibrosis?
Primary myelofibrosis (MF) is a chronic blood cancer in which excessive scar tissue forms in the bone marrow and impairs its ability to produce normal blood cells. Researchers believe MF may be caused by abnormal blood stem cells in the bone marrow

Is myelofibrosis painful?
The result: achy or tender bones and joint tenderness. Growths: Blood cells are supposed to form inside your bone marrow. But myelofibrosis might cause them to grow in other parts of your body, like your lungs, liver, spleen, and digestive tract. ... They cause sharp pain, swollen joints, and inflammation.

Can you survive myelofibrosis?
Survival. Myelofibrosis, similar to other malignancies, is a serious disease. Published estimates of median survival in primary myelofibrosis range from 2.25 to 11.25 years, depending on risk level.

What are the symptoms of myelofibrosis?
As disruption of normal blood cell production increases, signs and symptoms may include:

Feeling tired, weak or short of breath, usually because of anemia.

Pain or fullness below your ribs on the left side, due to an enlarged spleen.

Easy bruising.
Easy bleeding.

Excessive sweating during sleep (night sweats)
Fever.


Can myelofibrosis be inherited?
The disorder is generally not inherited because this type of mutation does not affect the reproductive cells (sperm and egg) only certain cells of the body (somatic). Although myelofibrosis can occur at any age, it typically develops after the age of 50 years.

Does bone marrow transplant cure myelofibrosis?
Allogeneic transplantation is the only known curative treatment for myelofibrosis. Several studies have shown survival rates of 40–60% after allogeneic stem cell transplantation (Table 2). The first transplants for myelofibrosis used myeloablative conditioning, usually total body radiation or busulfan-based treatment.

What are the symptoms of bone marrow problems?

Symptoms of bone marrow cancer

weakness and fatigue due to shortage of red blood cells (anemia)
bleeding and bruising due to low blood platelets (thrombocytopenia)
infections due to shortage of normal white blood cells (leukopenia)
extreme thirst.
frequent urination.
dehydration.
abdominal pain.
loss of appetite.

Will I die from MDS?
And they will die of MDS. So how do you die of MDS if you don't develop acute myeloid leukemia? You die of MDS because of the increasing profundity of the blood counts. They fall so low that we cannot keep up with transfusions and supportive care measures anymore, and eventually they succumb to infection or bleeding.

What causes itching in myelofibrosis?
Itching occurs as a result of the activity of cytokines (small proteins involved in cell signaling) associated with myeloproliferative neoplasms (MPNs) and because a certain type of cell called a mast cell may release substances called histamines, which cause itching.

How serious is essential thrombocythemia?
Older people with essential thrombocythemia are at risk of complications. ... The abnormal blood clotting of essential thrombocythemia can lead to a variety of potentially serious complications, including: Stroke. A clot that blocks blood flow to your brain can cause a stroke.


Can myelofibrosis metastasize?
Myelofibrosis may occur as a result of the spread of cancer (metastasis) to bone marrow from primary tumors. ... Myelofibrosis may occur as a secondary characteristic of another bone marrow disorder such as polycythemia vera, multiple myeloma, certain metabolic disorders, and/or chronic myeloid leukemia.


What does a bone marrow biopsy feel like?
The doctor makes a small incision, then inserts a hollow needle through the boneand into the bone marrow. Using a syringe attached to the needle, the doctor withdraws a sample of the liquid portion of the bone marrow. You may feel a brief sharp pain or stinging. The aspiration takes only a few minutes.

Who gets myelofibrosis?
How common is myelofibrosis? Myelofibrosis is a rare condition, with about 1.5 cases reported per 100,000 people each year in the United States. It occurs in both men and women. People of any age can have myelofibrosis, although it is more likely to be diagnosed in people over age 50.

Does jakafi prolong life?
Jakafi can help to relieve the signs and symptoms of myelofibrosis, such as enlargement of the spleen, night sweats, itching, and bone or muscle pain. ... Patients with primary myelofibrosis who are categorized with intermediate-2 or high IPSS risk have a median life expectancy of 4 years or less.

Why does the spleen enlarge?
An enlarged spleen can be caused by infections, cirrhosis and other liver diseases, blood diseases characterized by abnormal blood cells, problems with the lymph system, or other conditions. Other causes of an enlarged spleen include: Inflammatory diseases such as sarcoidosis, lupus, and rheumatoid arthritis.

What does pain from spleen feel like?
A common symptom of an enlarged spleen is a feeling of pain or discomfort in the upper left side of abdomen, where the spleen is located. You might also experience a feeling of fullness after only eating a small amount. This usually happens when the spleen becomes enlarged to the point that it presses on the stomach.

Can bone marrow cause pain?
Bone pain can occur in leukemia patients when the bone marrow expands from the accumulation of abnormal white blood cells and may manifest as a sharp pain or a dull pain, depending on the location. The long bones of the legs and arms are the most common location to experience this pain.

What is fibrosis of the bone marrow?
Bone marrow fibrosis (BMF) is characterized by the increased deposition of reticulin fibers and in some cases collagen fibers.

What does bone pain feel like?
Bone pain is extreme tenderness, aching, or other discomfort in one or more bones. It differs from muscle and joint pain because it's present whether you're moving or not. The pain is commonly linked to diseases that affect the normal function or structure of the bone.

How long can a person live with myelofibrosis?
The average survival is about 5 to 7 years. Unlike other myeloproliferative neoplasms, the name implies that these myeloid cells—they're the bone marrow cells—grow without control and overwhelm the bone marrow and blood.

How much does jakafi cost?
The cost for Jakafi oral tablet 5 mg is around $13,697 for a supply of 60 tablets, depending on the pharmacy you visit. Prices are for cash paying customers only and are not valid with insurance plans.

Is jakafi chemo?
Jakafi is the first and only medicine approved by the Food and Drug Administration (FDA) for the treatment of these patients. Jakafi is not chemotherapy. It is a targeted treatment that works to help keep the production of blood cells under control.

Can you drink alcohol while taking jakafi?
The most common side effects of Jakafi include dizziness and headache. These are not all the possible side effects of Jakafi. ... Do not drink grapefruit juice while taking Jakafi.

What foods heal the spleen?
Sesame, pumpkin or sunflower seeds, legumes, kidney beans, lightly cooked vegetables, small amounts of lean meats, figs, coconuts, grapes, cherries, dates, potatoes, sweet potatoes, brown rice, oats, rice, ginger, spring onions and pu'er tea are among the best foods for the organ

Can coughing rupture your spleen?
Rupture of the spleen secondary to trauma is a potentially life- threatening yet relatively common complication. ... Spontaneous splenic rupture has been reported after trivial insults such as vomiting and coughing.

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What is Primary myelofibrosis?

Primary myelofibrosis (also called chronic idiopathic myelofibrosis, agnogenic myeloid metaplasia) is a disorder in which normal bone marrow tissue is gradually replaced with a fibrous scar-like material. Over time, this leads to progressive bone marrow failure.

Under normal conditions, the bone marrow provides a fine network of fibres on which the stem cells can divide and grow. Specialised cells in the bone marrow known as fibroblasts make these fibres.

In primary myelofibrosis, chemicals released by high numbers of platelets and abnormal megakaryocytes (platelet forming cells) over-stimulate the fibroblasts. This results in the overgrowth of thick coarse fibres in the bone marrow, which gradually replace normal bone marrow tissue. Over time this destroys the normal bone marrow environment, preventing the production of adequate numbers of red cells, white cells and platelets. This results in anaemia, low platelet counts and the production of blood cells in areas outside the bone marrow for example in the spleen and liver, which become enlarged as a result.

Primary myelofibrosis is a rare chronic disorder diagnosed in an estimated 1 per 100,000 population. It can occur at any age but is usually diagnosed later in life, between the ages of 60 and 70 years. The cause of primary myelofibrosis remains largely unknown. It can be classified as either JAK2 mutation positive (having the JAK2 mutation) or negative (not having the JAK2 mutation).

Long-term exposure to high levels of benzene or very high doses of ionising radiation may increase the risk of primary myelofibrosis in a small number of cases. Around one third of people with myelofibrosis have been previously diagnosed with polycythaemia (post-polycythaemic myelofibrosis) or essential thrombocythaemia (post-ET myelofibrosis).
Symptoms and complications of primary myelofibrosis

Around 20 per cent of people have no symptoms of primary myelofibrosis when they are first diagnosed and the disorder is picked up incidentally as a result of a routine blood test. For others, symptoms develop gradually over time. Symptoms of anaemia are common and include unexplained tiredness, weakness, shortness of breath and palpitations. Other nonspecific symptoms include fever, unintended weight loss, pruritus (generalised itching) and excess sweating, especially at night.

Virtually all patients with primary myelofibrosis have an enlarged spleen (splenomegaly) when they are first diagnosed. In around a third of cases the spleen is very enlarged. Common symptoms include feelings of discomfort, pain or fullness in the upper left-side of the abdomen. An enlarged spleen may also cause pressure on your stomach causing a feeling of fullness, indigestion and a loss of appetite. Abdominal discomfort can also result from an enlarged liver (hepatomegaly), which occurs in around two-thirds of cases.

Other less common symptoms include bone and joint pain, and bleeding problems.

How is myelofibrosis diagnosed?

Primary myelofibrosis is diagnosed using a combination of a physical examination showing the presence of an enlarged spleen, blood tests and a bone marrow examination. Primary myelofibrosis is only diagnosed when other causes of marrow fibrosis (including leukaemia, lymphoma, other types of cancer that have spread to the bone marrow) have been ruled out.
Full blood count

People with primary myelofibrosis commonly present with varying degrees of anaemia. When examined under the microscope the red cells are often described as being ‘teardrop-shaped’. Higher than normal numbers of white cells and platelets may be found in the early stages of this disorder, but low white cell and platelet counts are common in more advanced disease.

Bone marrow examination

It is frequently impossible to obtain any samples of bone marrow fluid using a needle and syringe (bone marrow aspiration) due to marrow fibrosis. This is known as a ‘dry tap’. The bone marrow trephine biopsy typically shows abnormal fibrosis of the marrow cavity.

Cytogenetic and molecular analysis of blood and bone marrow cells is also carried out to help confirm the diagnosis and may help with prognosis. A mutation in JAK2 is found in about 50% of people with primary myelofibrosis. It is unclear at present why some patients with mutations in JAK2 develop myelofibrosis and others don’t.

How is myelofibrosis treated?
Some people have no symptoms when they are first diagnosed with primary myelofibrosis and do not require treatment straight away, apart from regular check-ups with their doctor to carefully monitor their disease.

For others treatment is largely supportive and is aimed at preventing complications due to low blood counts and an enlarged spleen (splenomegaly). This involves making every effort to improve your quality of life, by relieving any symptoms of anaemia or an enlarged spleen, and preventing and treating any complications that might arise from your disease or its treatment. This may include periodic blood transfusions and taking antibiotics to prevent and treat any infections.

A chemotherapy drug such as hydroxyurea, or low-doses of a drug called thalidomide may be used to reduce an enlarged spleen. In some cases, the surgical removal of the spleen (splenectomy) may be considered, especially when your spleen has enlarged so much that it is causing severe symptoms. A splenectomy may also be considered if you have an increased need for blood transfusions. This sometimes happens because the spleen is destroying blood cells, particularly platelets, at a very fast rate. Small doses of radiation to the spleen can also be given to reduce its size. This usually provides temporary relief for about 3 to 6 months.

Some younger patients who have a suitably matched donor may be offered an allogeneic (donor) stem cell transplant. This is a medical procedure that offers the only chance of cure for patients with myelofibrosis. It involves the use of very high doses of chemotherapy, with or without radiotherapy, followed by infusion of blood stem cells, which have been donated by a suitably matched donor. Stem cell transplants carry significant risks and are only suitable for a small minority of younger patients (usually under 60 years of age).

JAK2 inhibitors

JAK2 inhibitors work by blocking the activity of the JAK2 protein, which may lead to a reduction in splenomegaly and decreased symptoms. They also work in patients with myelofibrosis without the JAK2 mutation. Side effects may include worsening anaemia or a low platelet count. 

Ruxolitinib is the only JAK2 inhibitor currently licenced for use in Australia. A number of JAK2 inhibitors may be available in clinical trials or may become available in the near future. 

Prognosis

Primary myelofibrosis is generally regarded as an incurable disease but with treatment many people can remain comfortable and symptom-free for some time.

The natural course of the disease can vary considerably between individuals. In some people their disease remains stable for long periods and they are free to live a normal life with minimal interruptions from their disease or its treatment. For others, myelofibrosis progresses more quickly and people require treatment to help relieve symptoms of their disease. Transformation to a type of leukaemia called acute myeloid leukaemia occurs in between 10 and 20 per cent of cases.

Your doctor is the best person to give you an accurate prognosis regarding your disease as he or she has all the necessary information to make this assessment.Last updated on June 19th, 2019

Developed by the Leukaemia Foundation in consultation with people living with a blood cancer, Leukaemia Foundation support staff, haematology nursing staff and/or Australian clinical haematologists. This content is provided for information purposes only and we urge you to always seek advice from a registered health care professional for diagnosis, treatment and answers to your medical questions, including the suitability of a particular therapy, service, product or treatment in your circumstances. The Leukaemia Foundation shall not bear any liability for any person relying on the materials contained on this website.

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JAKAVI SIDE EFFECTS
Ruxolitinib
(rux oh LI ti nib)

Trade name: Jakafi™

Ruxolitinib is the generic for the trade drug Jakafi™. In some cases, health care professionals may use the trade name Jakafi™ when referring to the generic drug name ruxolitinib.

Drug type: Ruxolitinib is a targeted therapy. It is an oral receptor tyrosine kinase inhibitor - (For more detail, see "How this drug works," below.)

What Ruxolitinib Is Used For:
For the treatment of intermediate and high risk myelofibrosis.
For the treatment of acute graft-versus-host (GVHD) not responsive steroids, in adults and pediatric patients 12 years of older.

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Ruxolitinib Is Given:
Ruxolitinib is a pill, taken by mouth, with or without food.
Take ruxolitinib exactly as prescribed, even if you are feeling better.
Swallow ruxolitinib tablets whole. Do not chew, crush or break.
Those who have feeding tubes may also use the tablet. Mix each tablet with 40 mL of water. Stir for 10 minutes. Give within 6 hours of mixing. Flush the feeding tube with water before and after this drug is given. 

Do not change your dose or stop ruxolitinib unless your health care provider tells you to.
If a dose is missed, return to the usual dosing schedule. Do not take an additional dose.
Do not take extra doses of ruxolitinib. Call your health care provider right away if you take too much. 

Avoid grapefruit, grapefruit juice, and supplements that contain grapefruit extract while taking ruxolitinib. Grapefruit products may increase the amount of ruxolitinib.

The amount of ruxolitinib that you will receive depends on many factors, your general health or other health problems, and the type of cancer or condition being treated.

Side Effects:

Important things to remember about the side effects of ruxolitinib:

Most people do not experience all of the side effects listed.
Side effects are often predictable in terms of their onset and duration.
There are many options to help minimize or prevent side effects.
There is no relationship between the presence or severity of side effects and the effectiveness of the medication.

The following side effects are common (occurring in greater than 30%) for patients taking ruxolitinib:
Anemia
Thrombocytopenia

These side effects are less common side effects (occurring in about 10-29%) of patients receiving ruxolitinib:
Increased liver enzymes
Diarrhea
Bruising
Swelling
Neutropenia
Dizziness
Increased cholesterol
Shortness of breath
Nasopharyngitis
Headache
Constipation
Nausea & Vomiting
Insomnia

Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.
When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms: 

Fever of 100.4° F (38°C or higher, chills) 

Signs of a very bad reaction (wheezing, chest tightness, fever, itching, bad cough, blue or grey skin color, seizures, or swelling or the face, lips, tongue or throat)

Always inform your health care provider if you experience any unusual symptoms.

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following: 

Diarrhea (4-6 episodes in a 24-hour period)
Nausea (interferes with ability to eat and unrelieved with prescribed medication)
Vomiting (vomiting more than 4-5 times in a 24 hour period)
Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decrease amount of urine, or dizziness
Skin or the whites of your eyes turn yellow
Urine turns dark or brown (tea color)
Decreased appetite
Pain on the right side of your stomach
Bleed or bruise more easily than normal
Signs of infection (very bad sore throat, ear or sinus pain, cough, more sputum or change in color of sputum, pain with passing urine, mouth sores, wound that will not heal or anal itching or pain)
Headache, back pain or joint pain
Skin changes (rash, acne, itching, blisters, peeling, redness or swelling)

Always inform your health care provider if you experience any unusual symptoms.

Precautions:
Ruxolitinib may interact with many types of medications. Before starting ruxolitinib treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).

Do not receive any kind of immunization or vaccination without your doctor's approval while taking ruxolitinib. 

Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category C (use in pregnancy only when benefit to the mother outweighs risk to the fetus). 

For both men and women: Do not conceive a child (get pregnant) while taking ruxolitinib. Barrier methods of contraception, such as condoms, are recommended during treatment. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
Do not breast feed while taking this medication.
Self-Care Tips:
Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your healthcare provider.

Wash your hands often. Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.

Ask your doctor or nurse before scheduling dental appointments or procedures.

Use an electric razor to minimize bleeding.
Avoid contact sports or activities that could cause injury.
If you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals. Sucking on lozenges and chewing gum may also help.

Avoid sun exposure. Wear SPF 15 (or higher) sun block and protective clothing.

In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
Get plenty of rest.
Maintain good nutrition.
If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems. 

Monitoring and Testing:

You will be checked regularly by your health care professional while you are taking ruxolitinib. Testing may include blood work that checks blood counts and liver functions.
How Ruxolitinib Works:

Targeted therapy is the result of about 100 years of research dedicated to understanding the differences between cancer cells and normal cells. To date, cancer treatment has focused primarily on killing rapidly dividing cells because one feature of cancer cells is that they divide rapidly. Unfortunately, some of our normal cells divide rapidly too, causing multiple side effects.

Targeted therapy is about identifying other features of cancer cells. Scientists look for specific differences in the cancer cells and the normal cells. This information is used to create a targeted therapy to attack the cancer cells without damaging the normal cells, thus leading to fewer side effects. Each type of targeted therapy works a little bit differently but all interfere with the ability of the cancer cell to grow, divide, repair and/or communicate with other cells.

There are different types of targeted therapies, defined in three broad categories. Some targeted therapies focus on the internal components and function of the cancer cell. The targeted therapies use small molecules that can get into the cell and disrupt the function of the cells, causing them to die. There are several types of targeted therapy that focus on the inner parts of the cells. Other targeted therapies target receptors that are on the outside of the cell. Therapies that target receptors are also known as monoclonal antibodies. Antiangiogenesis inhibitors target the blood vessels that supply oxygen to the cells, ultimately causing the cells to starve.

Ruxolitinib is a targeted therapy that targets and binds to the tyrosine kinase receptors and inhibits Janus Associated Kinases (JAK1 and JAK2) which mediate the signaling of a number of cytokines and growth factors that are important for hematopoiesis and immune function. By binding to these receptors, ruxolitinib blocks important pathways that promote cell division. Myelofibrosis (MF) is a myeloproliferative neoplasm (MPN) known to be associated with dysregulated JAK1 and JAK2 signaling. Patients with MF who either carry the JAK2 V617 mutation or does not have the JAK2 V617F mutation may both respond to ruxolitinib.

Research continues to identify which cancers may be best treated with targeted therapies and to identify additional targets for more types of cancer.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.